1
|
Reyes-Diaz M, Malca J, Konda KA, Vargas SK, Calvo GM, Caceres CF, Klausner JD. HIV Infection Modifies the Role of Prior Treponema pallidum Infection in the Clinical Presentation of Early Syphilis Among Adult Patients From Sexually Transmitted Infection Clinics in Peru. Sex Transm Dis 2024; 51:415-419. [PMID: 38372543 DOI: 10.1097/olq.0000000000001950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND We aimed to compare the clinical presentations (symptomatic vs. asymptomatic) with prior Treponema pallidum infection status (first infection vs. reinfection) among people with early syphilis. METHODS We used data from PICASSO, a cohort study in Peru that enrolled people with active syphilis from May 2019 to August 2021. Study participants had early syphilis and a prior syphilis serological test result within the prior 12 months to determine prior T. pallidum infection status. We calculated prevalence ratios (PRs) of symptomatic clinical presentation (primary or secondary syphilis) by prior T. pallidum infection status, stratified by HIV infection status. In addition, we explored the association of prior T. pallidum infection status and lesion presentation, stratified by primary and secondary syphilis cases, using the Fisher exact test. RESULTS We include 84 T. pallidum reinfection cases and 61 first infection cases. We found increased frequency of symptomatic clinical presentation among first-infection cases (39% vs. 20%; PR, 1.94; P = 0.014). This association was stronger among persons living without HIV infection (38% vs. 7%; adjusted PR, 6.63; P = 0.001) in comparison to those living with HIV infection (45% vs. 34%; adjusted PR, 1.38; P = 0.458). Among secondary syphilis cases, more participants from the reinfection group reported that their lesions improved 1 week after treatment (100% vs. 29%, P = 0.045) compared with those with a first infection. Among the primary syphilis cases, all participants reported that their lesions improved 1 week after treatment. CONCLUSIONS Prior syphilis was associated with a decreased prevalence of symptomatic reinfection, especially among persons not living with HIV infection.
Collapse
Affiliation(s)
- Michael Reyes-Diaz
- From the Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad-CIISSS, Lima, Perú
| | - Joselito Malca
- From the Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad-CIISSS, Lima, Perú
| | | | | | - Gino M Calvo
- From the Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad-CIISSS, Lima, Perú
| | - Carlos F Caceres
- From the Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad-CIISSS, Lima, Perú
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| |
Collapse
|
2
|
Konda KA, Qquellon J, Torres TS, Vega-Ramirez EH, Elorreaga O, Guillén-Díaz-Barriga C, Diaz-Sosa D, Hoagland B, Guanira JV, Benedetti M, Pimenta C, Vermandere H, Bautista-Arredondo S, Veloso VG, Grinsztejn B, Caceres CF. Awareness of U = U among Sexual and Gender Minorities in Brazil, Mexico, and Peru: Differences According to Self-reported HIV Status. AIDS Behav 2024:10.1007/s10461-024-04336-9. [PMID: 38662277 DOI: 10.1007/s10461-024-04336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 04/26/2024]
Abstract
The slogan Undetectable equals Untransmittable (U = U) communicates that people living with HIV (PLHIV) who are on antiretroviral therapy (ART) will not transmit HIV to their sexual partners. We describe awareness of U = U among sexual and gender minorities (SGM) living in Brazil, Mexico, and Peru by self-reported HIV status (PLHIV, negative, unknown) during 2021 using an online survey. We estimated two models using Poisson regression for each population group: Model A including socio-demographic factors (country, gender, age, race, education, and income), and then Model B including taking ART (for PLHIV) or risk behavior, ever-taking PrEP, and HIV risk perception (for HIV-negative or of unknown HIV status). A total of 21,590 respondents were included (Brazil: 61%, Mexico: 30%, Peru: 9%). Among HIV-negative (74%) and unknown status (12%), 13% ever used PrEP. Among PLHIV (13%), 93% reported current use of ART. Awareness of U = U was 89% in both Brazil and Mexico, which was higher than in Peru 64%. Awareness of U = U was higher among PLHIV (96%) than HIV-negative (88%) and HIV-unknown (70%). In multivariate models, PLHIV with lower education were less aware of U = U, while those taking ART were more aware. Among HIV-negative, non-cisgender, lower income, and those with lower education had lower awareness of U = U, while individuals ever using PrEP had higher awareness. In conclusion, awareness of U = U varied by HIV status, socio-demographic characteristics, and HIV risk behavior. The concept of U = U should be disseminated through educational strategies and include a focus on SGM to combat HIV stigma.
Collapse
Affiliation(s)
- K A Konda
- Keck School of Medicine, University of Southern California, 1845 N Soto St, Los Angeles, CA, 90032, USA.
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru.
| | - J Qquellon
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
| | - T S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - E H Vega-Ramirez
- Instituto Nacional de Psiquiatria Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - O Elorreaga
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
| | - C Guillén-Díaz-Barriga
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - D Diaz-Sosa
- Instituto Nacional de Psiquiatria Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - B Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - J V Guanira
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
| | - M Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - C Pimenta
- Departmento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissiveis, Brazilian Ministry of Health, Rio de Janeiro, Brazil
| | - H Vermandere
- Instituto Nacional de Salud Pública (INSP), Mexico City, Mexico
| | | | - V G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - B Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - C F Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
| |
Collapse
|
3
|
Haynes AM, Konda KA, Romeis E, Siebert J, Vargas SK, Reyes Diaz M, Phan A, Caceres CF, Giacani L, Klausner JD. Evaluation of a minimal array of Treponema pallidum antigens as biomarkers for syphilis diagnosis, infection staging, and response to treatment. Microbiol Spectr 2024; 12:e0346623. [PMID: 38095465 PMCID: PMC10782976 DOI: 10.1128/spectrum.03466-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024] Open
Abstract
IMPORTANCE This manuscript explores the host humoral response to selected antigens of the syphilis agent during infection to evaluate their potential use as diagnostic tests and markers for treatment.
Collapse
Affiliation(s)
- Austin M. Haynes
- Department of Medicine, Division of Allergy and Infectious Diseases, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Kelika A. Konda
- Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Emily Romeis
- Department of Medicine, Division of Allergy and Infectious Diseases, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | | | - Silver K. Vargas
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Michael Reyes Diaz
- Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Amber Phan
- Department of Medicine, Division of Allergy and Infectious Diseases, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Carlos F. Caceres
- Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, Harborview Medical Center, University of Washington, Seattle, Washington, USA
- Department of Global Health, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Jeffrey D. Klausner
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
4
|
Eguiluz M, Qquellon J, Vargas SK, Reyes-Diaz M, Konda KA, Caceres CF, Klausner JD. Molecular Characterization of Genital and Extragenital Lesions With the PlexPCR VHS Assay in Patients Diagnosed With Syphilis. Open Forum Infect Dis 2023; 10:ofad483. [PMID: 37869408 PMCID: PMC10588620 DOI: 10.1093/ofid/ofad483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Background Syphilis diagnosis relies on immunologic markers and clinical protocols. However, syphilitic lesions can be confused with other genital ulcer diseases. Methods Using a PlexPCR VHS assay, we analyzed lesion DNA samples from 87 individuals who were clinically diagnosed with early syphilis infection and had at least 1 positive serologic test result. DNA was detected by the PlexPCR VHS multiplex assay and β-globin genes. Results Among the participants, 99% (86/87) had a positive rapid treponemal test result. DNA was successfully detected in 91% (79/87) of the lesion samples. PlexPCR VHS identified 5 herpes simplex virus (HSV)/Treponema pallidum coinfections (2 HSV-1 and 3 HSV-2), only T pallidum DNA in 62% (49/79), and only HSV-2 in 12.7% (10/79). While 19% (15/79) were negative for all pathogens, none were varicella zoster virus positive. The PlexPCR VHS had 68.4% agreement with the clinical diagnosis. Conclusions Since the PlexPCR VHS detects multiple organisms simultaneously, it can help to confirm actual syphilis and identify other pathogen coinfections or the pathogen causing the ulcer.
Collapse
Affiliation(s)
- Maria Eguiluz
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jazmin Qquellon
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Michael Reyes-Diaz
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kelika A Konda
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carlos F Caceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
5
|
Marcus U, Veras M, Casabona J, Caceres CF, Lachowsky N, Schink SB, Schmidt AJ. Comparison of the burden of self-reported bacterial sexually transmitted infections among men having sex with men across 68 countries on four continents. BMC Public Health 2023; 23:1008. [PMID: 37254096 DOI: 10.1186/s12889-023-15946-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/20/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are in general more vulnerable to sexually transmitted infections (STIs) than the heterosexual men population. However, surveillance data on STI diagnoses lack comparability across countries due to differential identification of MSM, diagnostic standards and methods, and screening guidelines for asymptomatic infections. METHODS We compared self-reported overall diagnostic rates for syphilis, gonorrhea, and chlamydia infections, and diagnostic rates for infections that were classified to be symptomatic in the previous 12 months from two online surveys. They had a shared methodology, were conducted in 68 countries across four continents between October 2017 and May 2018 and had 202,013 participants. RESULTS Using multivariable multilevel regression analysis, we identified age, settlement size, number of sexual partners, condom use for anal intercourse, testing frequency, sampling rectal mucosa for extragenital testing, HIV diagnosis, and pre-exposure prophylaxis use as individual-level explanatory variables. The national proportions of respondents screened and diagnosed who notified some or all of their sexual partners were used as country-level explanatory variables. Combined, these factors helped to explain differences in self-reported diagnosis rates between countries. The following differences were not explained by the above factors: self-reported syphilis diagnoses were higher in Latin America compared with Europe, Canada, Israel, Lebanon, and the Philippines (aORs 2.30 - 3.71 for symptomatic syphilis compared to Central-West Europe); self-reported gonorrhea diagnoses were lower in Eastern Europe and in Latin America compared with all other regions (aORs 0.17-0.55 and 0.34 - 0.62 for symptomatic gonorrhea compared to Central-West Europe); and self-reported chlamydia diagnoses were lower in Central East and Southeast Europe, South and Central America, and the Philippines (aORs 0.25 - 0.39 for symptomatic chlamydia for Latin American subregions compared to Central West Europe). CONCLUSIONS Possible reasons for differences in self-reported STI diagnosis prevalence likely include different background prevalence for syphilis and syndromic management without proper diagnosis, and different diagnostic approaches for gonorrhea and chlamydia.
Collapse
Affiliation(s)
- Ulrich Marcus
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany.
| | - Maria Veras
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr Cesario Mota Jr 61, São Paulo, SP, 01221-020, Brazil
| | | | - Carlos F Caceres
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nathan Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
- Community Based Research Centre Society, Vancouver, BC, Canada
| | - Susanne B Schink
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Axel J Schmidt
- Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
6
|
Qquellon J, Vargas SK, Eguiluz M, Vasquez F, Durand D, Allan-Blitz LT, Konda KA, Ochoa TJ, Caceres CF, Klausner JD. Extra-genital Neisseria gonorrhoeae infections with genetic mutations conferring ciprofloxacin resistance among men who have sex with men and transgender women in Lima, Peru. Int J STD AIDS 2023; 34:245-250. [PMID: 36637128 PMCID: PMC9950594 DOI: 10.1177/09564624221147326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The increasing prevalence of drug-resistant Neisseria gonorrhoeae (NG) infections has caused great concern. Ciprofloxacin remains the empiric antimicrobial recommended to treat NG infections in Peru disregarding the susceptibility profile of circulating NG strains. We report the prevalence of individuals infected with NG strains presenting mutations in the gyrA gene that confers ciprofloxacin resistance. METHODS We conducted a descriptive study assessing extragenital swab samples collected from a cohort of men who have sex with men and transgender women in Lima, Peru. Anal and pharyngeal NG positive swabs for Aptima Combo 2 assay (Hologic Inc., USA) were used for DNA extraction. We performed TaqMan real time PCR assays to detect a point mutation at codon Ser91 of the gyrase A (gyrA) gene. RESULTS From 156 individuals who had at least one positive sample for NG reported by the Aptima assay, 80 individuals had at least one amplified DNA for the gyrA gene. We found that 67 of them (84.0%) were infected with a gyrA-mutated NG strain at the Ser91 codon. CONCLUSIONS We report a high prevalence of gyrA mutation conferring ciprofloxacin resistance among individuals with extragenital NG infection. Empirical treatment of NG needs to be urgently updated in Peru in concordance with international guidelines.
Collapse
Affiliation(s)
- Jazmin Qquellon
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Silver K Vargas
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
- School of Public Health and
Administration, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Maria Eguiluz
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Francesca Vasquez
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - David Durand
- Instituto de Medicina Tropical
“Alexander Von Humboldt”, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Lao-Tzu Allan-Blitz
- Division of Global Health Equity,
Department of Medicine, Brigham and Women’s
Hospital, Boston, MA, USA
| | - Kelika A Konda
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
- Division of Infectious Diseases,
David Geffen School of Medicine, University of
California, Los Angeles, CA, USA
| | - Theresa J Ochoa
- Instituto de Medicina Tropical
“Alexander Von Humboldt”, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Carlos F Caceres
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Department of Population and Public
Health Sciences, Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA
| |
Collapse
|
7
|
Guillen-Diaz-Barriga C, Diaz-Sosa D, Torres TS, Konda KA, Robles-Garcia R, Hoagland B, Benedetti M, Pimenta C, Grinsztejn B, Caceres CF, Veloso VG, Vega-Ramirez H. Correction to: HIV Risk Perception and Pre-Exposure Prophylaxis (PrEP) Awareness Among Transgender Women from Mexico. AIDS Behav 2023; 27:1003. [PMID: 36348193 DOI: 10.1007/s10461-022-03887-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Centli Guillen-Diaz-Barriga
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Col. San Lorenzo Huipulco Alc. Tlalpan, 14370, Mexico City, Mexico
| | - Dulce Diaz-Sosa
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Col. San Lorenzo Huipulco Alc. Tlalpan, 14370, Mexico City, Mexico
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | - Rebeca Robles-Garcia
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Col. San Lorenzo Huipulco Alc. Tlalpan, 14370, Mexico City, Mexico
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Hamid Vega-Ramirez
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Col. San Lorenzo Huipulco Alc. Tlalpan, 14370, Mexico City, Mexico.
| |
Collapse
|
8
|
Torres TS, Nascimento AR, Coelho LE, Konda KA, Vega-Ramirez EH, Elorreaga OA, Diaz-Sosa D, Hoagland B, Guanira JV, Pimenta C, Benedetti M, Caceres CF, Veloso VG, Grinsztejn B. Preferences for PrEP modalities among gay, bisexual, and other men who have sex with men from Brazil, Mexico, and Peru: a cross-sectional study. Ther Adv Infect Dis 2023; 10:20499361231153548. [PMID: 36814515 PMCID: PMC9940158 DOI: 10.1177/20499361231153548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/11/2023] [Indexed: 02/20/2023] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) scale-up is urgent to reduce new HIV cases among gay, bisexual, and other men who have sex with men (MSM) in Latin America. Different PrEP modalities may increase PrEP uptake and adherence, especially among young MSM. Objectives To assess preferences for PrEP modalities among MSM from Brazil, Mexico, and Peru. Design Cross-sectional web-based study (March-May 2018) targeting MSM through advertisements on Grindr, Hornet, and Facebook. We included MSM aged ⩾ 18 years and who reported HIV-negative status. Methods We assessed preferences for PrEP modalities with the following question: 'Considering that all following PrEP modalities were available, which one would you prefer considering a scale from 1 to 3 (1 = most preferred): daily oral PrEP, event-driven PrEP (ED-PrEP), and long-acting injectable PrEP'. We assessed factors associated with each most preferred PrEP modality per country using multivariable logistic regression models. Results A total of 19,457 MSM completed the questionnaire (Brazil: 58%; Mexico: 31%; Peru: 11%); median age was 28 years [interquartile range (IQR): 24-34]. Overall, injectable PrEP was the most preferred modality [42%; 95% confidence interval (CI): 41-43], followed by daily PrEP (35%; 95% CI: 34-35), and ED-PrEP (23%; 95% CI: 23-24). In multivariable models, preferring injectable PrEP was associated with PrEP awareness in all three countries, while PrEP eligibility only in Brazil. Preferring daily PrEP was associated with younger age and lower income in Brazil and Mexico, and lower education only in Brazil. The odds of preferring ED-PrEP were lower among MSM aware and eligible for PrEP in Brazil and Mexico. Conclusions Long-acting injectable PrEP was the preferred PrEP modality among MSM in Brazil, Mexico, and Peru, especially those aware and eligible for PrEP. Public health interventions to increase PrEP modalities literacy and availability in Latin America are urgent especially among MSM of young age, lower income, and lower education.
Collapse
Affiliation(s)
| | | | - Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | | | | | - Dulce Diaz-Sosa
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | | | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| |
Collapse
|
9
|
Marcus U, Jonas K, Berg R, Veras MA, Caceres CF, Casabona J, Schink SB, Schmidt AJ. Association of internalised homonegativity with partner notification after diagnosis of syphilis or gonorrhoea among men having sex with men in 49 countries across four continents. BMC Public Health 2023; 23:8. [PMID: 36597057 PMCID: PMC9809117 DOI: 10.1186/s12889-022-14891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Partner notification (PN) after a sexually transmitted infection (STI) diagnosis is being promoted as a means to interrupt transmission chains. We investigated whether Internalised Homonegativity (IH) is associated with PN among men having sex with men (MSM). METHODS PN, defined as notifying at least one partner after diagnosis of syphilis and gonorrhoea, was queried in two internet-based self-completion surveys conducted between Oct 2017 and May 2018 in 68 countries in Europe, Latin America, Canada, and the Philippines. IH is defined by a man's level of agreement or disagreement with negative social beliefs about male homosexuality. Covariates included in a multivariate regression model with a random intercept at country level were age, HIV diagnosis, partnership status, sexual self-efficacy, HIV serostatus communication during last sex with a non-steady partner, place where this partner was met, and PN-related socio-historical background of the country of residence. We grouped countries in three areas: North- and Central-Western European countries plus Canada, former socialist countries, and Latin-American/Mediterranean countries plus the Philippines. In each of the three areas individuals were assigned to 4 subgroups based on IH quartiles and PN rates were determined for each subgroup. RESULTS PN rates were calculated for 49 countries (excluding countries with less than 10 diagnoses). Mean proportions of MSM notifying their partners were 68.1% and 72.9% after syphilis and gonorrhoea diagnoses, respectively. PN rates were lower in Latin American countries and the Philippines compared to European countries. Within Europe, a North-South divide with lower PN rates in Mediterranean countries was observed. In each of the three regions we mostly observed a stepwise increase of PN rates with decreasing IH. Regression analysis showed lower IH scores associated with higher PN rates. Higher perceived self-efficacy, living in a partnership, and HIV status communication were positively associated with PN. Men who had met their last partner in a gay social venue were more likely to have notified their partners of a syphilis diagnosis compared to men who had met this partner online. Men with diagnosed HIV were less likely to report PN. CONCLUSIONS We could demonstrate that IH was associated with PN among MSM across all countries included in our analysis. Reducing cultural homophobia and ensuring inclusive policies may contribute to STI prevention and control.
Collapse
Affiliation(s)
- Ulrich Marcus
- grid.13652.330000 0001 0940 3744Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Kai Jonas
- grid.5012.60000 0001 0481 6099Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Rigmor Berg
- grid.418193.60000 0001 1541 4204Division for the Health Services, Norwegian Institute of Public Health, Oslo, Norway ,grid.10919.300000000122595234Department of Community Medicine, University of Tromso, Tromso, Norway
| | - Maria Amelia Veras
- grid.419014.90000 0004 0576 9812Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr Cesario Mota Jr 61, São Paulo, SP 01221-020 Brazil
| | - Carlos F. Caceres
- grid.11100.310000 0001 0673 9488Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jordi Casabona
- Health Department, Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Generalitat de Catalunya, Badalona, Spain ,grid.429186.00000 0004 1756 6852Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiologia Y Salud Pública (CIBERESP), Madrid, Spain ,grid.7080.f0000 0001 2296 0625Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Susanne B. Schink
- grid.13652.330000 0001 0940 3744Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Axel J. Schmidt
- grid.8991.90000 0004 0425 469XDepartment of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, Sigma Research, London, UK
| |
Collapse
|
10
|
Reyes-Díaz M, Celly A, Folch C, Lorente N, Stuardo V, Veras MA, Barros H, Meireles P, Ramírez D, Jonas KJ, Marcus U, Schmidt AJ, Caceres CF, Casabona J. Latin American Internet Survey for Men who have Sex with Men (LAMIS-2018): Design, methods and implementation. PLoS One 2022; 17:e0277518. [PMID: 36395121 PMCID: PMC9671301 DOI: 10.1371/journal.pone.0277518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/28/2022] [Indexed: 11/19/2022] Open
Abstract
Despite men-who-have-sex-with-men (MSM) from Latin America (LA) are still a vulnerable population for known health-related conditions and social problems, availability of comparable data across LA countries for assessment and monitoring purposes is limited. The objective of this article is to present the study design and the questionnaire of LAMIS-2018 (Latin America MSM Internet Survey), its recruitment strategy, rates and sources by country, and the lessons learned from its implementation. LAMIS-2018 was a cross-sectional, internet-based survey targeting MSM living in 18 LA countries (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela) that gathered data about sexual behaviors, HIV/STI and viral hepatitis knowledge, prophylactic use of antiretrovirals, psychosocial health, and access to sexual health services. The survey went online for four months and was available in three languages (Spanish, Portuguese, and Dutch). Promotion was carried out using dating apps, websites, social networks, and by community-based and academic organizations of each participating country directly in gay venues and in their own premises. Overall, 64,655 MSM participated in LAMIS-2018. Dating apps and websites were the most important recruitment source in most countries, except for Honduras, Nicaragua, and Suriname, where community-based organizations recruited most of the participants. Beyond the LAMIS-2018 implementation description, we highlight the feasibility of such a study in this context, based on the collaboration between community-based and academic organizations to obtain a large sample of MSM in the region. LAMIS-2018 data will contribute to identify determinants of risk behaviors and prevention needs of vulnerable MSM populations in each country of the region.
Collapse
Affiliation(s)
- Michael Reyes-Díaz
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad (CIISSS), Universidad Peruana Cayetano Heredia, San Martín de Porres, Peru
| | - Ana Celly
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Madrid, Spain
| | - Cinta Folch
- Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- * E-mail:
| | - Nicolas Lorente
- Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Madrid, Spain
- Coalition PLUS
| | - Valeria Stuardo
- Instituto de Salud Pública, Universidad Andrés Bello, Santiago, Chile
| | - Maria Amelia Veras
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Henrique Barros
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, Porto, Portugal
| | - Paula Meireles
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, Porto, Portugal
| | | | - Kai J. Jonas
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | | | - Axel J. Schmidt
- Sigma Research, Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Carlos F. Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad (CIISSS), Universidad Peruana Cayetano Heredia, San Martín de Porres, Peru
| | - Jordi Casabona
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
11
|
Konda KA, Torres TS, Mariño G, Ramos A, Moreira RI, Leite IC, Cunha M, Jalil EM, Hoagland B, Guanira JV, Benedetti M, Pimenta C, Vermandere H, Bautista‐Arredondo S, Vega‐Ramirez H, Veloso VG, Caceres CF, Grinsztejn B. Factors associated with long-term HIV pre-exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study. J Int AIDS Soc 2022; 25 Suppl 5:e25974. [PMID: 36225148 PMCID: PMC9557020 DOI: 10.1002/jia2.25974] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The HIV epidemic continues to disproportionately impact Latin‐American transgender women (TGW). We assessed factors associated with long‐term pre‐exposure prophylaxis (PrEP) engagement and adherence among TGW enrolled in the Implementation of PrEP (ImPrEP) study, the largest PrEP demonstration study in Latin America. Methods HIV‐negative TGW aged ≥18 years reporting 1+eligibility criteria in the 6 months prior to enrolment (e.g. sex partner known to be living with HIV, condomless anal sex [CAS], transactional sex or having a sexually transmitted infection [STI]) who could safely take PrEP were enrolled. Follow‐up visits were conducted at 4 weeks and then quarterly. We conducted logistic regression to identify factors associated with long‐term PrEP engagement (3+ follow‐up visits in 52 weeks) and complete self‐reported adherence (no missed pills in the past 30 days) during follow‐up. For both outcomes, we constructed multivariable models controlling for country, socio‐demographics, sexual behaviour, substance use, STIs and self‐reported adherence at 4 weeks (long‐term engagement outcome only). Results From March 2018 to June 2021, ImPrEP screened 519 TGW, enrolled 494 (Brazil: 190, Mexico: 66 and Peru: 238) and followed them for 52 weeks. At baseline, 27.5% of TGW were aged 18–24 years, 67.8% were mixed‐race and 31.6% had >secondary education. Most, 89.9% reported CAS, 61.9% had >10 sex partners and 71.9% reported transactional sex. HIV incidence was 1.82 cases per 100 person‐years (95% confidence interval [CI]: 0.76–4.38). Almost half of TGW (48.6%) had long‐term PrEP engagement, which was positively associated with reporting complete adherence at week 4 (aOR:2.94 [95%CI:1.88–4.63]) and was inversely associated with reporting CAS with unknown‐HIV partner (aOR:0.52 [95%CI:0.34–0.81]), migration (aOR:0.54 [95%CI:0.34–0.84]), and being from Mexico (aOR:0.28 [95%CI:0.14–0.53]). Self‐reported adherence was associated with TGW aged >34 (aOR:1.61 [95%CI:1.10–2.34]) compared to those aged 25–34 and those with >secondary education (aOR:1.55 [95%CI:1.10–2.19]) and was lower among TGW from Peru (aOR:0.29 [95%CI:0.21–0.41]) or reporting PrEP‐related adverse effects (aOR:0.63 [95%CI:0.42–0.92]). Conclusions Although TGW were willing to enrol in ImPrEP, long‐term PrEP engagement and complete self‐reported adherence were limited, and HIV incidence remained relatively high. A successful HIV prevention agenda should include trans‐specific interventions supporting oral PrEP and exploring long‐acting PrEP strategies for TGW.
Collapse
Affiliation(s)
- Kelika A. Konda
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDALimaPeru
| | - Thiago S. Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Gabriela Mariño
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDALimaPeru
| | - Alessandra Ramos
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Ronaldo I. Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Iuri C. Leite
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP‐Fiocruz)Rio de JaneiroBrazil
| | - Marcelo Cunha
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP‐Fiocruz)Rio de JaneiroBrazil
| | - Emilia M. Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Juan V. Guanira
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDALimaPeru
| | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | | | | | | | - Hamid Vega‐Ramirez
- Instituto Nacional de Psiquiatria Ramon de la Fuente MuñizMexico CityMexico
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Carlos F. Caceres
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDALimaPeru
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | | |
Collapse
|
12
|
Lieberman NAP, Armstrong TD, Chung B, Pfalmer D, Hennelly CM, Haynes A, Romeis E, Wang QQ, Zhang RL, Kou CX, Ciccarese G, Conte ID, Cusini M, Drago F, Nakayama SI, Lee K, Ohnishi M, Konda KA, Vargas SK, Eguiluz M, Caceres CF, Klausner JD, Mitja O, Rompalo A, Mulcahy F, Hook EW, Hoffman IF, Matoga MM, Zheng H, Yang B, Lopez-Medina E, Ramirez LG, Radolf JD, Hawley KL, Salazar JC, Lukehart SA, Seña AC, Parr JB, Giacani L, Greninger AL. High-throughput nanopore sequencing of Treponema pallidum tandem repeat genes arp and tp0470 reveals clade-specific patterns and recapitulates global whole genome phylogeny. Front Microbiol 2022; 13:1007056. [PMID: 36204625 PMCID: PMC9531955 DOI: 10.3389/fmicb.2022.1007056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Sequencing of most Treponema pallidum genomes excludes repeat regions in tp0470 and the tp0433 gene, encoding the acidic repeat protein (arp). As a first step to understanding the evolution and function of these genes and the proteins they encode, we developed a protocol to nanopore sequence tp0470 and arp genes from 212 clinical samples collected from ten countries on six continents. Both tp0470 and arp repeat structures recapitulate the whole genome phylogeny, with subclade-specific patterns emerging. The number of tp0470 repeats is on average appears to be higher in Nichols-like clade strains than in SS14-like clade strains. Consistent with previous studies, we found that 14-repeat arp sequences predominate across both major clades, but the combination and order of repeat type varies among subclades, with many arp sequence variants limited to a single subclade. Although strains that were closely related by whole genome sequencing frequently had the same arp repeat length, this was not always the case. Structural modeling of TP0470 suggested that the eight residue repeats form an extended α-helix, predicted to be periplasmic. Modeling of the ARP revealed a C-terminal sporulation-related repeat (SPOR) domain, predicted to bind denuded peptidoglycan, with repeat regions possibly incorporated into a highly charged β-sheet. Outside of the repeats, all TP0470 and ARP amino acid sequences were identical. Together, our data, along with functional considerations, suggests that both TP0470 and ARP proteins may be involved in T. pallidum cell envelope remodeling and homeostasis, with their highly plastic repeat regions playing as-yet-undetermined roles.
Collapse
Affiliation(s)
- Nicole A. P. Lieberman
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, United States
| | - Thaddeus D. Armstrong
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, United States
| | - Benjamin Chung
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, United States
| | - Daniel Pfalmer
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, United States
| | - Christopher M. Hennelly
- Division of Infectious Diseases, Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Austin Haynes
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Emily Romeis
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Qian-Qiu Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Rui-Li Zhang
- Department of Dermatology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cai-Xia Kou
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Giulia Ciccarese
- Section of Dermatology, Department of Health Sciences, San Martino University Hospital, Genoa, Italy
| | - Ivano Dal Conte
- Sexual Health Center, Department of Prevention, ASL Città di Torino, Turin, Italy
| | - Marco Cusini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Drago
- Section of Dermatology, Department of Health Sciences, San Martino University Hospital, Genoa, Italy
| | - Shu-ichi Nakayama
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kenichi Lee
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kelika A. Konda
- Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Silver K. Vargas
- Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
- School of Public Health and Administration “Carlos Vidal Layseca”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Eguiluz
- Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
| | - Carlos F. Caceres
- Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
| | - Jeffrey D. Klausner
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Oriol Mitja
- Fight Aids and Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Barcelona, Spain
- Lihir Medical Centre, International SOS, Londolovit, Papua New Guinea
| | - Anne Rompalo
- Department of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Fiona Mulcahy
- Department of Genito Urinary Medicine and Infectious Diseases, St. James’s Hospital, Dublin, Ireland
| | - Edward W. Hook
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Irving F. Hoffman
- Division of Infectious Diseases, Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- UNC Project-Malawi, Lilongwe, Malawi
| | - Mitch M. Matoga
- Division of Infectious Diseases, Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- UNC Project-Malawi, Lilongwe, Malawi
| | - Heping Zheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Institute for Global Health and Sexually Transmitted Infections, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Institute for Global Health and Sexually Transmitted Infections, Guangzhou, China
| | - Eduardo Lopez-Medina
- Centro Internacional de Entrenamiento e Investigaciones Medicas (CIDEIM), Cali, Colombia
- Centro de Estudios en Infectología Pediátrica (CEIP), Cali, Colombia
| | - Lady G. Ramirez
- Centro Internacional de Entrenamiento e Investigaciones Medicas (CIDEIM), Cali, Colombia
- Universidad ICESI, Cali, Colombia
| | - Justin D. Radolf
- Department of Medicine, UConn Health, Farmington, CT, United States
- Department of Pediatrics, UConn Health, Farmington, CT, United States
- Department of Molecular Biology and Biophysics, UConn Health, Farmington, CT, United States
- Department of Immunology, UConn Health, Farmington, CT, United States
- Department of Genetics and Genome Sciences, UConn Health, Farmington, CT, United States
| | - Kelly L. Hawley
- Department of Medicine, UConn Health, Farmington, CT, United States
- Department of Pediatrics, UConn Health, Farmington, CT, United States
- Department of Immunology, UConn Health, Farmington, CT, United States
- Division of Infectious Diseases and Immunology, Connecticut Children’s Medical Center, Hartford, CT, United States
| | - Juan C. Salazar
- Department of Pediatrics, UConn Health, Farmington, CT, United States
- Department of Immunology, UConn Health, Farmington, CT, United States
- Division of Infectious Diseases and Immunology, Connecticut Children’s Medical Center, Hartford, CT, United States
| | - Sheila A. Lukehart
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
- Department of Global Health, University of Washington School of Medicine, Seattle, WA, United States
| | - Arlene C. Seña
- Division of Infectious Diseases, Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jonathan B. Parr
- Division of Infectious Diseases, Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lorenzo Giacani
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
- Department of Global Health, University of Washington School of Medicine, Seattle, WA, United States
| | - Alexander L. Greninger
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, United States
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| |
Collapse
|
13
|
Vega-Ramirez H, Torres TS, Guillen-Diaz C, Pimenta C, Diaz-Sosa D, Konda KA, da Cunha ARC, Robles-Garcia R, Benedetti M, Hoagland B, Bezerra DRB, Caceres CF, Grinsztejn B, Veloso VG. Awareness, knowledge, and attitudes related to HIV pre-exposure prophylaxis and other prevention strategies among physicians from Brazil and Mexico: cross-sectional web-based survey. BMC Health Serv Res 2022; 22:532. [PMID: 35459177 PMCID: PMC9027096 DOI: 10.1186/s12913-022-07900-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background In order to end the HIV epidemic by 2030, combination HIV prevention including pre-exposure prophylaxis (PrEP) should be widely available, especially for the most vulnerable populations. In Latin America and the Caribbean (LAC), only 14 out of 46 countries have access to PrEP. In Brazil and Mexico, PrEP has been provided at no cost through the Public Health System since 2017 and 2021, respectively. Thus, HIV physicians’ perspectives about PrEP and other prevention strategies may differ. This study aimed to compare awareness, knowledge, and attitudes related to PrEP and other prevention strategies among HIV physicians from Brazil and Mexico. Methods Cross-sectional, web-based survey targeting physicians who prescribe antiretrovirals from both countries. Participants answered questions on socio-demographic, medical experience, awareness, knowledge, and attitudes towards PrEP and other HIV prevention strategies. We stratified all variables per country and compared frequencies using Chi-square, Fisher exact, and Wilcoxon-Mann-Whitney tests, as appropriate. Results From January–October 2020, 481 HIV physicians were included: 339(70.5%) from Brazil, 276(57.4%) male, and median age was 43 years (IQR = 36–53). Awareness of PrEP did not differ between Brazil and Mexico (84.6%), while awareness of other prevention strategies, including post-exposure prophylaxis and new PrEP technologies, was higher in Brazil. More Brazilians perceived U=U as completely accurate compared to Mexicans (74.0% vs. 62.0%, P < .001). Willingness to prescribe PrEP was 74.2%, higher among Brazilians (78.2%, P = .01). Overall, participants had concerns about consistent access to PrEP medication and the risk of antiretroviral resistance in case of acute HIV infection or seroconversion. The main barriers reported were assumptions that users could have low PrEP knowledge (62.0%) or limited capacity for adherence (59.0%). Compared to Brazilians, Mexicans reported more concerns and barriers to PrEP prescription (all; P ≤ .05), except for consistent access to PrEP medication and the lack of professionals to prescribe PrEP (both; P ≤ .01). Conclusions Although awareness of PrEP was similar in Brazil and Mexico, differences in knowledge and attitudes may reflect the availability and stage of PrEP implementation in these countries. Strengthening and increasing information on PrEP technologies and other HIV prevention strategies among HIV physicians could improve their comfort to prescribe these strategies and facilitate their scale-up in LAC. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07900-y.
Collapse
Affiliation(s)
- Hamid Vega-Ramirez
- Center for Research in Global Mental Health, National Institute of Psychiatry Ramon de la Fuente Muñiz, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Alc. Tlalpan, 14370, Mexico City, Mexico.
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Centli Guillen-Diaz
- Center for Research in Global Mental Health, National Institute of Psychiatry Ramon de la Fuente Muñiz, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Alc. Tlalpan, 14370, Mexico City, Mexico
| | | | - Dulce Diaz-Sosa
- Center for Research in Global Mental Health, National Institute of Psychiatry Ramon de la Fuente Muñiz, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Alc. Tlalpan, 14370, Mexico City, Mexico
| | - Kelika A Konda
- Center for Interdisciplinary Research in Sexuality, Health, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Rebeca Robles-Garcia
- Center for Research in Global Mental Health, National Institute of Psychiatry Ramon de la Fuente Muñiz, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Alc. Tlalpan, 14370, Mexico City, Mexico
| | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Daniel R B Bezerra
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Carlos F Caceres
- Center for Interdisciplinary Research in Sexuality, Health, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
14
|
Elorreaga OA, Torres TS, Vega-Ramirez EH, Konda KA, Hoagland B, Benedetti M, Pimenta C, Diaz-Sosa D, Robles-Garcia R, Grinsztejn B, Caceres CF, Veloso VG. Awareness, willingness and barriers to HIV Self-testing (HIVST) among Men who Have Sex with Men (MSM) in Brazil, Mexico, and Peru: A web-based cross-sectional study. PLOS Glob Public Health 2022; 2:e0000678. [PMID: 36962436 PMCID: PMC10021908 DOI: 10.1371/journal.pgph.0000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
HIV self-testing (HIVST) is an essential tool within the combined HIV prevention package and has been available in Latin America since 2015. However, HIVST use among key populations remains low. This study describes awareness, willingness, and barriers to HIVST among MSM in Brazil, Mexico, and Peru. A cross-sectional web-based survey was advertised in two geosocial networking apps (Grindr and Hornet) and Facebook in 2018. We included cisgender men ≥18 years old who self-reported HIV-negative status. We used multivariable Poisson regression models to calculate adjusted prevalence ratios (aPR) to assess the factors associated with willingness to use HIVST for each country. A total of 18,916 completed the survey, 59% from Brazil, 30% from Mexico, and 11% from Peru. Overall, 20% of MSM had never tested for HIV. Awareness and willingness to use HIVST were higher in Brazil than in Peru and Mexico (p < .001). Across the countries, the patterns of association of willingness with HIVST barriers were similar. Most participants think post-test counseling is essential and that dealing with a positive result would be difficult (aPR 1.13 to 1.37, range of aPRs across the three countries). Having the knowledge to deal with a positive HIVST resulted in increased willingness to use HIVST (aPR range: 1.11 to 1.22), while a lack of trust in HIVST compared to HIV testing in clinics was inversely associated (aPR range: 0.80 to 0.90). In general, willingness to use HIVST was associated with higher income (aPR range: 1.49 to 1.97), higher education (aPR range: 1.13 to 1.42), and willingness to use PrEP (aPR range: 1.19 to 1.72). Efforts to increase HIVST knowledge and resolve perceived barriers are warranted, especially among MSM with lower income and education from Brazil, Mexico, and Peru. Personalized virtual counseling could be crucial among this population. In addition, those willing to use HIVST are also willing to use PrEP. It indicates that HIVST delivery could be incorporated into PrEP programs within the Brazilian Public Health System and eventually in Mexico and Peru.
Collapse
Affiliation(s)
- Oliver A Elorreaga
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | - Kelika A Konda
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Cristina Pimenta
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Dulce Diaz-Sosa
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico DF, Mexico
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Carlos F Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| |
Collapse
|
15
|
Jiron JP, Sandoval C, Enciso JC, De Vasconcelos AS, Blondeel K, Bakunina N, Lesco G, Toskin I, Stephenson R, Caceres CF. Correction to: Brief intervention to prevent HIV, STI and unintended pregnancies: preliminary results of a feasibility study from the perspective of healthcare providers in Peru. BMC Health Serv Res 2021; 21:1366. [PMID: 34961535 PMCID: PMC8713391 DOI: 10.1186/s12913-021-07417-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jean Pierre Jiron
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Clara Sandoval
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Carlos Enciso
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ana Sofía De Vasconcelos
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nataliia Bakunina
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,Institute for Leadership and Health Management, I.M, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Galina Lesco
- National Resource Centre in Youth Friendly Health Services NEOVITA, Chisinau, Republic of Moldova
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Rob Stephenson
- Department of Systems, Population and Leadership, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA.,Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, USA
| | - Carlos F Caceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
16
|
Lieberman NAP, Lin MJ, Xie H, Shrestha L, Nguyen T, Huang ML, Haynes AM, Romeis E, Wang QQ, Zhang RL, Kou CX, Ciccarese G, Dal Conte I, Cusini M, Drago F, Nakayama SI, Lee K, Ohnishi M, Konda KA, Vargas SK, Eguiluz M, Caceres CF, Klausner JD, Mitjà O, Rompalo A, Mulcahy F, Hook EW, Lukehart SA, Casto AM, Roychoudhury P, DiMaio F, Giacani L, Greninger AL. Treponema pallidum genome sequencing from six continents reveals variability in vaccine candidate genes and dominance of Nichols clade strains in Madagascar. PLoS Negl Trop Dis 2021; 15:e0010063. [PMID: 34936652 PMCID: PMC8735616 DOI: 10.1371/journal.pntd.0010063] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/06/2022] [Accepted: 12/06/2021] [Indexed: 11/19/2022] Open
Abstract
In spite of its immutable susceptibility to penicillin, Treponema pallidum (T. pallidum) subsp. pallidum continues to cause millions of cases of syphilis each year worldwide, resulting in significant morbidity and mortality and underscoring the urgency of developing an effective vaccine to curtail the spread of the infection. Several technical challenges, including absence of an in vitro culture system until very recently, have hampered efforts to catalog the diversity of strains collected worldwide. Here, we provide near-complete genomes from 196 T. pallidum strains-including 191 T. pallidum subsp. pallidum-sequenced directly from patient samples collected from 8 countries and 6 continents. Maximum likelihood phylogeny revealed that samples from most sites were predominantly SS14 clade. However, 99% (84/85) of the samples from Madagascar formed two of the five distinct Nichols subclades. Although recombination was uncommon in the evolution of modern circulating strains, we found multiple putative recombination events between T. pallidum subsp. pallidum and subsp. endemicum, shaping the genomes of several subclades. Temporal analysis dated the most recent common ancestor of Nichols and SS14 clades to 1717 (95% HPD: 1543-1869), in agreement with other recent studies. Rates of SNP accumulation varied significantly among subclades, particularly among different Nichols subclades, and was associated in the Nichols A subclade with a C394F substitution in TP0380, a ERCC3-like DNA repair helicase. Our data highlight the role played by variation in genes encoding putative surface-exposed outer membrane proteins in defining separate lineages, and provide a critical resource for the design of broadly protective syphilis vaccines targeting surface antigens.
Collapse
Affiliation(s)
- Nicole A. P. Lieberman
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
| | - Michelle J. Lin
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
| | - Hong Xie
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
| | - Lasata Shrestha
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
| | - Tien Nguyen
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
| | - Meei-Li Huang
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
| | - Austin M. Haynes
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Emily Romeis
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Qian-Qiu Wang
- Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
- National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Rui-Li Zhang
- Department of Dermatology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cai-Xia Kou
- Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
- National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Giulia Ciccarese
- Health Sciences Department, Section of Dermatology, San Martino University Hospital, Genoa, Italy
| | - Ivano Dal Conte
- STI Clinic, Infectious Diseases Unit, University of Turin, Turin, Italy
| | - Marco Cusini
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Drago
- Health Sciences Department, Section of Dermatology, San Martino University Hospital, Genoa, Italy
| | - Shu-ichi Nakayama
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kenichi Lee
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kelika A. Konda
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Silver K. Vargas
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
| | - Maria Eguiluz
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
| | - Carlos F. Caceres
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
| | - Jeffrey D. Klausner
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Oriol Mitjà
- Fight Aids and Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Barcelona, Spain
- Lihir Medical Centre-International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Anne Rompalo
- Department of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
| | - Fiona Mulcahy
- Department of Genito Urinary Medicine and Infectious Diseases, St James’s Hospital, Dublin, Ireland
| | - Edward W. Hook
- Department of Medicine, University of Alabama, Birmingham, Birmingham, Alabama, United States of America
| | - Sheila A. Lukehart
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Amanda M. Casto
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Pavitra Roychoudhury
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Frank DiMaio
- Department of Biochemistry, University of Washington, Seattle, Washington, United States of America
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Alexander L. Greninger
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| |
Collapse
|
17
|
Jiron JP, Sandoval C, Enciso JC, De Vasconcelos AS, Blondeel K, Bakunina N, Lesco G, Toskin I, Stephenson R, Caceres CF. Brief intervention to prevent HIV, STI and unintended pregnancies: preliminary results of a feasibility study from the perspective of healthcare providers in Peru. BMC Health Serv Res 2021; 21:1225. [PMID: 34772418 PMCID: PMC8590268 DOI: 10.1186/s12913-021-07229-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Brief interventions have proven to be valuable instruments for the treatment and care of clients with diverse health needs, due to their potential to impact both the individual and the population. In this regard, the Brief Sexuality-Related Communication (BSC) is presented as a viable and effective alternative for addressing sexual and reproductive health problems, assessing risk behaviors and motivating clients to generate behavioral change. Since health providers are key actors in treatment and prevention, it is essential to know their perceptions about the BSC intervention, as well as its acceptability in different contexts, with diverse client populations. Thus, the following paper reflects the findings of the perceptions and experiences of health providers in Peru from the first phase of the Feasibility study of a BSC intervention to prevent STIs and unintended pregnancies. Methods This is the first phase of a multisite and multiphase study of the feasibility of a BSC intervention. We conducted twenty in-depth interviews (IDI) with health care providers (physicians, obstetricians, psychologists, nurses and peer counselors) recruited from three health care institutions in Peru: The Tahuantinsuyo Bajo Maternal and Child Center (CMI) and the San José Maternal and Child Center, both located in the capital city, Lima; and La Caleta Hospital located in Chimbote, northern coast of Peru. Participating health providers included those working at the HIV/STI Reference service and the family planning/reproductive health service. The IDI addressed three domains: 1) Acceptability of the BSC intervention; 2) Perceived willingness to implement the BSC intervention; and 3) Considerations for the Implementation of the BSC intervention. Results Health providers expressed high acceptance of the BSC intervention, considering it as a useful and effective instrument to address sexual and reproductive health problems with all clients; however, some providers had some concerns about the real impact of the intervention to achieve significant behavior change. On the other hand, health providers showed high willingness to learn and implement the BSC intervention, affirming their commitment to learn new techniques and strategies that could allow them to improve their knowledge and the quality of their care. Health care providers consider it necessary to take into account the barriers that arise in the implementation of the BSC intervention, such as the structural limitations to access, the providers’ abilities to deliver the intervention effectively, and the participants’ reception of the intervention. Finally, providers consider it essential to establish the BSC intervention in a normative framework that allows it to receive the support of the health departments and eventually enforces implementation. Conclusions Health providers consider the BSC intervention as an interesting and exciting behavioral intervention to deal with the sexual and reproductive health issues existing in different populations, and seemed highly willing to adapt and implement it, hoping that it become beneficial to all client populations to prevent HIV/STIs and unintended pregnancies.
Collapse
Affiliation(s)
- Jean Pierre Jiron
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Clara Sandoval
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Carlos Enciso
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ana Sofía De Vasconcelos
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nataliia Bakunina
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,Institute for Leadership and Health Management, I.M, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Galina Lesco
- National Resource Centre in Youth Friendly Health Services NEOVITA, Chisinau, Republic of Moldova
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Rob Stephenson
- Department of Systems, Population and Leadership, School of Nursing, University of Michigan, Ann Arbor, USA.,Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
| | - Carlos F Caceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
18
|
Torres TS, Coelho LE, Konda KA, Vega-Ramirez EH, Elorreaga OA, Diaz-Sosa D, Hoagland B, Pimenta C, Benedetti M, Grinsztejn B, Caceres CF, Veloso VG. Low socioeconomic status is associated with self-reported HIV positive status among young MSM in Brazil and Peru. BMC Infect Dis 2021; 21:726. [PMID: 34332552 PMCID: PMC8325787 DOI: 10.1186/s12879-021-06455-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 07/23/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite efforts to stop HIV epidemic in Latin America, new HIV cases continue to increase in the region especially among young MSM (YMSM). This study aims to assess if sociodemographic characteristics are associated with self-reported HIV positive status among YMSM from three Latin American countries. METHODS Cross-sectional web-based survey advertised on dating apps (Grindr and Hornet) and Facebook in Brazil, Mexico and Peru. For this analysis, we included YMSM aged 18-24 years who self-reported their HIV status. We used multivariable logistic regression models for each country separately to verify if sociodemographic characteristics (race, education and income) were associated with HIV self-reported status after adjusting for behavior characteristics (sexual attraction and steady partner). RESULTS Among 43,687 MSM who initiated the questionnaire, 27,318 (62.5%) reported their HIV status; 7001 (25.6%) of whom were YMSM. Most YMSM (83.4%) reported an HIV test in the past year, and 15.7% reported an HIV positive status in Peru, 8.4% in Mexico and 7.7% in Brazil. In adjusted models, low-income was associated with higher odds of self-reported HIV positive status in Brazil (aOR = 1.33, 95%CI: 1.01-1.75) and Peru (aOR = 1.56, 95%CI: 1.02-2.40), but not in Mexico. Lower education was associated with higher odds of self-reported HIV positive status only in Brazil (aOR = 1.35, 95%CI: 1.05-1.75). CONCLUSIONS In this large, cross-country study, self-reported HIV positive status among YMSM was high. Lower socioeconomic status was associated with higher odds of self-reported HIV positive status in Brazil and Peru. There is an urgent need for HIV prevention interventions targeting YMSM, and efforts to address low-income YMSM are especially needed in Peru and Brazil.
Collapse
Affiliation(s)
- Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av Brasil, 4365 Manguinhos, Rio de Janeiro, 21040-360, Brazil.
| | - Lara E Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av Brasil, 4365 Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | | | | | | | - Dulce Diaz-Sosa
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av Brasil, 4365 Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | | | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av Brasil, 4365 Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av Brasil, 4365 Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | | | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av Brasil, 4365 Manguinhos, Rio de Janeiro, 21040-360, Brazil
| |
Collapse
|
19
|
Paredes JL, Navarro R, Cabrera DM, Diaz MM, Mejia F, Caceres CF. [Challenges to the continuity of care of people living with HIV throughout the COVID-19 crisis in Peru]. Rev Peru Med Exp Salud Publica 2021; 38:166-170. [PMID: 34190910 DOI: 10.17843/rpmesp.2021.381.6471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/11/2020] [Indexed: 11/06/2022]
Abstract
The COVID-19 pandemic and societal response implemented may interact with the ongoing HIV epidemic in multiple ways. There are approximately 87000 people living with HIV (PLWH) who are at risk of developing COVID-19 in Peru and 67,000 of them are on antiretroviral therapy (ART) and at risk of limitations in their access to ART, compromising their adherence and their health during the pandemic. Finally, the potential effect of the pandemic on the mental health of PLWH is not documented. This opinion aims to: describe the clinical implications of the HIV/SARS-CoV-2 coinfection; discuss the challenges to the continuity of care of PLWH in Peru during the COVID-19 crisis; and comment possible implications that the COVID-19 crisis may pose on the mental health of PLWH.
Collapse
Affiliation(s)
- Jose L Paredes
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Rafaella Navarro
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Diego M Cabrera
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States
| | - Monica M Diaz
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Fernando Mejia
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Carlos F Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad, Lima, Perú
| |
Collapse
|
20
|
Kojima N, Siebert JC, Maecker H, Rosenberg-Hasson Y, Leon SR, Vargas SK, Konda KA, Caceres CF, Klausner JD. The Application of Cytokine Expression Assays to Differentiate Active From Previously Treated Syphilis. J Infect Dis 2021; 222:690-694. [PMID: 32189000 DOI: 10.1093/infdis/jiaa127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/17/2020] [Indexed: 01/05/2023] Open
Abstract
To investigate the role of serum cytokine assays to distinguish between active from treated syphilis among serofast patients, we recruited individuals into a prospective cohort study. Participants underwent routine syphilis screening. We selected specimens from a majority cohort of serofast participants with treated and active syphilis. We analyzed specimens with a 62-cytokine multiplex bead-based enzyme-linked immunosorbent assay. Cytokines, brain-derived neurotrophic factor and tumor necrosis factor β, were most predictive. We built a decision tree that was 82.4% accurate, 100% (95% confidence interval, 82%-100%) sensitive, and 45% (18%-75%) specific. Our decision tree differentiated between serum specimens from serofast participants with treated syphilis versus active syphilis.
Collapse
Affiliation(s)
- Noah Kojima
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - Holden Maecker
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, California, USA
| | - Yael Rosenberg-Hasson
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, California, USA
| | - Segundo R Leon
- School of Medical Technology, Universidad Privada San Juan Bautista, Lima, Peru
| | - Silver K Vargas
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kelika A Konda
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos F Caceres
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | |
Collapse
|
21
|
Haynes AM, Fernandez M, Romeis E, Mitjà O, Konda KA, Vargas SK, Eguiluz M, Caceres CF, Klausner JD, Giacani L. Transcriptional and immunological analysis of the putative outer membrane protein and vaccine candidate TprL of Treponema pallidum. PLoS Negl Trop Dis 2021; 15:e0008812. [PMID: 33497377 PMCID: PMC7864442 DOI: 10.1371/journal.pntd.0008812] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/05/2021] [Accepted: 01/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background An effective syphilis vaccine should elicit antibodies to Treponema pallidum subsp. pallidum (T. p. pallidum) surface antigens to induce pathogen clearance through opsonophagocytosis. Although the combination of bioinformatics, structural, and functional analyses of T. p. pallidum genes to identify putative outer membrane proteins (OMPs) resulted in a list of potential vaccine candidates, still very little is known about whether and how transcription of these genes is regulated during infection. This knowledge gap is a limitation to vaccine design, as immunity generated to an antigen that can be down-regulated or even silenced at the transcriptional level without affecting virulence would not induce clearance of the pathogen, hence allowing disease progression. Principal findings We report here that tp1031, the T. p. pallidum gene encoding the putative OMP and vaccine candidate TprL is differentially expressed in several T. p. pallidum strains, suggesting transcriptional regulation. Experimental identification of the tprL transcriptional start site revealed that a homopolymeric G sequence of varying length resides within the tprL promoter and that its length affects promoter activity compatible with phase variation. Conversely, in the closely related pathogen T. p. subsp. pertenue, the agent of yaws, where a naturally-occurring deletion has eliminated the tprL promoter region, elements necessary for protein synthesis, and part of the gene ORF, tprL transcription level are negligible compared to T. p. pallidum strains. Accordingly, the humoral response to TprL is absent in yaws-infected laboratory animals and patients compared to syphilis-infected subjects. Conclusion The ability of T. p. pallidum to stochastically vary tprL expression should be considered in any vaccine development effort that includes this antigen. The role of phase variation in contributing to T. p. pallidum antigenic diversity should be further studied. Syphilis is still an endemic disease in many low- and middle-income countries and has been resurgent in high-income nations for almost two decades now. In endemic areas, syphilis still causes significant morbidity and mortality in patients, particularly when its causative agent, the bacterium Treponema pallidum subsp. pallidum is transmitted to the fetus during pregnancy. Although there are significant ongoing efforts to identify an effective syphilis vaccine to bring into clinical trials within the decade in the U.S., such efforts are partially hindered by the lack of knowledge on transcriptional regulation of many genes encoding vaccine candidates. Here, we start addressing this knowledge gap for the putative outer membrane protein (OMP) and vaccine candidates TprL, encoded by the tp1031 gene. As we previously reported for other putative OMP-encoding genes of the syphilis agent, tprL transcription level appears to be affected by the length of a homopolymeric sequence of guanosines (Gs) located within the gene promoter. This is a mechanism known as phase variation and often involved in altering the surface antigenic profile of a bacterial pathogen to facilitate immune evasion and/or adaptation to the host milieu.
Collapse
Affiliation(s)
- Austin M. Haynes
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Mark Fernandez
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Emily Romeis
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Oriol Mitjà
- Fight Aids and Infectious Diseases Foundation, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
- Lihir Medical Centre-International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Kelika A. Konda
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
- David Geffen School of Medicine, Division of Infectious Diseases, University of California Los Angeles, Los Angeles, United States of America
| | - Silver K. Vargas
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
- School of Public Health and Administration “Carlos Vidal Layseca”, Universidad Peruana Cayetano-Heredia, Lima, Peru
| | - Maria Eguiluz
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
| | - Carlos F. Caceres
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
| | - Jeffrey D. Klausner
- David Geffen School of Medicine, Division of Infectious Diseases, University of California Los Angeles, Los Angeles, United States of America
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| |
Collapse
|
22
|
Osias E, Hung P, Giacani L, Stafylis C, Konda KA, Vargas SK, Reyes-Díaz EM, Comulada WS, Haake DA, Haynes AM, Caceres CF, Klausner JD. Investigation of syphilis immunology and Treponema pallidum subsp. pallidum biology to improve clinical management and design a broadly protective vaccine: study protocol. BMC Infect Dis 2020; 20:444. [PMID: 32576149 PMCID: PMC7309211 DOI: 10.1186/s12879-020-05141-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/08/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The syphilis epidemic continues to cause substantial morbidity and mortality worldwide, particularly in low- and middle-income countries, despite several recent disease control initiatives. Though our understanding of the pathogenesis of this disease and the biology of the syphilis agent, Treponema pallidum subsp. pallidum has improved over the last two decades, further research is necessary to improve clinical diagnosis and disease management protocols. Additionally, such research efforts could contribute to the identification of possible targets for the development of an effective vaccine to stem syphilis spread. METHODS This study will recruit two cohorts of participants with active syphilis infection, one with de novo infection, one with repeat infection. Whole blood specimens will be collected from each study participant at baseline, 4, 12, 24, 36, and 48 weeks, to track specific markers of their immunological response, as well as to compare humoral reactivity to Treponema pallidum antigens between the two groups. Additionally, we will use serum specimens to look for unique cytokine patterns in participants with early syphilis. Oral and blood samples, as well as samples from any syphilitic lesions present, will also be collected to sequence any Treponema pallidum DNA found. DISCUSSION By furthering our understanding of syphilis pathogenesis and human host immune response to Treponema pallidum, we will provide important data that will help in development of new point-of-care tests that could better identify active infection, leading to improved syphilis diagnosis and management. Findings could also contribute to vaccine development efforts.
Collapse
Affiliation(s)
- Ethan Osias
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Phoebe Hung
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Chrysovalantis Stafylis
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Kelika A Konda
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.,Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - E Michael Reyes-Díaz
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - W Scott Comulada
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - David A Haake
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Austin M Haynes
- Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Carlos F Caceres
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| |
Collapse
|
23
|
Allan-Blitz LT, Konda KA, Vargas SK, Wang X, Segura ER, Fazio BM, Calvo GM, Caceres CF, Klausner JD. The development of an online risk calculator for the prediction of future syphilis among a high-risk cohort of men who have sex with men and transgender women in Lima, Peru. Sex Health 2019; 15:261-268. [PMID: 30021680 DOI: 10.1071/sh17118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/24/2017] [Indexed: 12/22/2022]
Abstract
Background Syphilis incidence worldwide has rebounded since 2000, particularly among men who have sex with men (MSM). A predictive model for syphilis infection may inform prevention counselling and use of chemoprophylaxis. METHODS Data from a longitudinal cohort study of MSM and transgender women meeting high-risk criteria for syphilis who were followed quarterly for 2 years were analysed. Incidence was defined as a four-fold increase in rapid plasma reagin (RPR) titres or new RPR reactivity if two prior titres were non-reactive. Generalised estimating equations were used to calculate rate ratios (RR) and develop a predictive model for 70% of the dataset, which was then validated in the remaining 30%. An online risk calculator for the prediction of future syphilis was also developed. RESULTS Among 361 participants, 22.0% were transgender women and 34.6% were HIV-infected at baseline. Syphilis incidence was 19.9 cases per 100-person years (95% confidence interval (CI) 16.3-24.3). HIV infection (RR 2.22; 95% CI 1.54-3.21) and history of syphilis infection (RR 2.23; 95% 1.62-3.64) were significantly associated with incident infection. The final predictive model for syphilis incidence in the next 3 months included HIV infection, history of syphilis, number of male sex partners and sex role for anal sex in the past 3 months, and had an area under the curve of 69%. The online syphilis risk calculator based on those results is available at: www.syphrisk.net. CONCLUSIONS Using data from a longitudinal cohort study among a population at high risk for syphilis infection in Peru, we developed a predictive model and online risk calculator for future syphilis infection. The predictive model for future syphilis developed in this study has a moderate predictive accuracy and may serve as the foundation for future studies.
Collapse
Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
| | - Kelika A Konda
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
| | - Silver K Vargas
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Xiaoyan Wang
- Department of General Internal Medicine and Health Services Research, University of California Los Angeles, 911 Broxton Avenue, Los Angeles, CA, 90095, USA
| | - Eddy R Segura
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
| | - Boris M Fazio
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Gino M Calvo
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Carlos F Caceres
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Jeffrey D Klausner
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
| |
Collapse
|
24
|
Kojima N, Siebert JC, Maecker H, Rosenberg-Hasson Y, Leon SR, Vargas SK, Konda KA, Caceres CF, Klausner JD. Cytokine expression in Treponema pallidum infection. J Transl Med 2019; 17:196. [PMID: 31186010 PMCID: PMC6558693 DOI: 10.1186/s12967-019-1947-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/03/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Current syphilis tests cannot distinguish between active and past syphilis among patients with serofast rapid plasma reagin (RPR) titers. We investigated whether cytokine profiles might provide insight in the differentiation of active and treated syphilis. METHODS We collected quarterly serum samples from participants at risk for incident syphilis in a prospective cohort study of men and male-to-female transgender women. We defined incident syphilis as a new RPR titer ≥ 1:8 or a fourfold increase from a prior RPR titer and a positive Treponema pallidum particle agglutination assay. We measured cytokine expression using a 63-multiplex bead-based Luminex assay (eBiosciences/Affymetrix, San Diego, California, USA). We used tertile bins and Chi square tests to identify differences in proportions of cytokines between samples from patients with active and treated syphilis. We constructed a network of cytokine profiles from those findings. We used R software (R version 3.4.1, R, Vienna, Austria) to fit models. RESULTS We identified 20 pairs of cytokines (out of 1953 possible pairs) that differed between active and treated syphilis. From those, we identified three cytokine networks of interest: an Eotaxin-Rantes-Leptin network, a Mig-IL1ra-Trail-CD40L network, and an IL12p40-IL12p70 network. CONCLUSIONS Differences in cytokine profiles are present among men and male-to-female transgender women with active and treated syphilis. Cytokine assays may be a potentially useful tool for identifying active syphilis among patients with serologic syphilis reactivity.
Collapse
Affiliation(s)
- N Kojima
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | | | - H Maecker
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, 94305, USA
| | - Y Rosenberg-Hasson
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, 94305, USA
| | - S R Leon
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, USA
| | - S K Vargas
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, USA
| | - K A Konda
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, USA
| | - C F Caceres
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, USA
| | - J D Klausner
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, 90024, USA
| |
Collapse
|
25
|
Allan-Blitz LT, Herrera MC, Calvo GM, Vargas SK, Caceres CF, Klausner JD, Konda KA. Venue-Based HIV-Testing: An Effective Screening Strategy for High-Risk Populations in Lima, Peru. AIDS Behav 2019; 23:813-819. [PMID: 30506350 DOI: 10.1007/s10461-018-2342-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Venue-based testing may improve screening efforts for HIV and syphilis, thereby reducing transmission. We offered onsite rapid dual HIV and syphilis testing at venues popular among MSM and/or transgender women in Lima, Peru. We used Poisson regression to calculate adjusted prevalence ratios (aPRs) for factors associated with each infection. Most (90.4%) of the 303 participants would test more frequently if testing was available at alternative venues. New cases of HIV (69) and syphilis infection (84) were identified. HIV was associated with recent sex work (aPR 1.11; 95% CI 1.02-1.22), sex with a partner of unknown serostatus (aPR 1.18; 95% CI 1.09-1.27), exclusively receptive anal sex role (aPR 1.16; 95% CI 1.03-1.30) or versatile sex role (aPR 1.17; 95% CI 1.06-1.30) compared to insertive. Syphilis was associated with reporting role versatility (aPR = 2.69; 95% CI 1.52-5.74). Sex work venues had higher syphilis prevalence 47% versus 28% in other venues, p value = 0.012. Venue-based testing may improve case finding.
Collapse
Affiliation(s)
- Lao-Tzu Allan-Blitz
- David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - M Christina Herrera
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Gino M Calvo
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos F Caceres
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Kelika A Konda
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Fielding School of Public Health, University of California, Los Angeles, USA.
| |
Collapse
|
26
|
Bristow CC, Kojima N, Lee SJ, Leon SR, Ramos LB, Konda KA, Brown B, Caceres CF, Klausner JD. HIV and syphilis testing preferences among men who have sex with men and among transgender women in Lima, Peru. PLoS One 2018; 13:e0206204. [PMID: 30372465 PMCID: PMC6205634 DOI: 10.1371/journal.pone.0206204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 10/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) and transgender women in Peru are at high risk for acquiring syphilis and HIV infection. The World Health Organization highly recommends screening for HIV and syphilis to reduce morbidity and mortality associated with untreated infections. We aimed to identify factors associated with dual testing preferences for HIV and syphilis infection among MSM and transgender women in Lima, Peru. METHODS We used conjoint analysis, an innovative method for systematically estimating consumer preferences. We created eight hypothetical test profiles varying across six dichotomous attributes: cost (free vs. $4), potential for false positive syphilis result (no false positive vs. some risk of false positive), time-to-result (20 minutes vs. 1 week), blood draw method (finger prick vs. venipuncture), test type (rapid vs. laboratory), and number of draws (1 vs. 2). We fit a conjoint analysis model for each participant using a simple main effects ANOVA. Attribute importance values were calculated using percentages from relative ranges in the attribute's utility values. Results were summarized across participants and averages were reported. RESULTS We recruited 415 MSM/transgender women over 18 years of age from two STD clinics in Lima, Peru. No potential for syphilis false positive result (no false positive vs. some potential for false positive) had the largest average impact on willingness to use the test and on average accounted for 23.8% of test type preference, followed by cost (free vs. ~USD$4; 21.6%), time to results (20 minutes vs. 1 week; 17.4%), number of blood draws (1 draw vs. 2 draws; 13.8%), method of blood draw (fingerprick vs. venipuncture; 13.7%), and test type (rapid POC vs. laboratory; 9.7%). CONCLUSION MSM/transgender women in Peru prioritized accuracy, cost, timeliness and number of blood draws for HIV and syphilis testing. Implementing a low cost, accurate, rapid and dual testing strategy for HIV and syphilis could improve screening uptake and accessibility of testing to accelerate time to treatment.
Collapse
Affiliation(s)
- Claire C. Bristow
- Department of Medicine, University of California San Diego, La Jolla, CA, United States of America
| | - Noah Kojima
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Sung-Jae Lee
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Segundo R. Leon
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Lourdes B. Ramos
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kelika A. Konda
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Brandon Brown
- Department of Medicine, University of California Riverside, Riverside, CA, United States of America
| | - Carlos F. Caceres
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D. Klausner
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| |
Collapse
|
27
|
Vargas SK, Konda KA, Leon SR, Brown B, Klausner JD, Lindan C, Caceres CF. The Relationship Between Risk Perception and Frequency of HIV Testing Among Men Who Have Sex with Men and Transgender Women, Lima, Peru. AIDS Behav 2018; 22:26-34. [PMID: 29313193 DOI: 10.1007/s10461-017-2018-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
HIV infections in Peru are concentrated among men who have sex with men (MSM) and transgender women (TW). HIV testing rates among them remain low, delaying entrance into care. We assessed the prevalence of frequent HIV testing (at least every 6 months) and associated factors among 310 MSM and TW who attend sexual health clinics in Lima, Peru, and who reported that they were HIV seronegative or unaware of their status. Only 39% of participants tested frequently, and 22% had never tested; 29% reported that they were at low or no risk for acquiring HIV. Reporting low or no risk for acquiring HIV was associated with frequent testing (adjusted prevalence ratio [aPR] = 1.53, 95% CI 1.13-2.08); those reporting unprotected anal sex were less likely to test frequently (aPR = 0.66, 95% CI 0.50-0.87). HIV prevalence was 12% and did not vary by risk perception categories. This at-risk population tests infrequently and may not understand the risk of having unprotected sex.
Collapse
Affiliation(s)
- S K Vargas
- Laboratory of Sexual Health, Center for Interdisciplinary Research on Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Laboratorio de Salud Sexual, Laboratorios de Investigación y Desarrollo (LID), Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru.
| | - K A Konda
- Program in Global Health, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Unit of Health, Sexuality and Human Development, Center for Interdisciplinary Research on Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - S R Leon
- Laboratory of Sexual Health, Center for Interdisciplinary Research on Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - B Brown
- Center for Healthy Communities, School of Medicine, University of California Riverside, Riverside, CA, USA
| | - J D Klausner
- Program in Global Health, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - C Lindan
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - C F Caceres
- Unit of Health, Sexuality and Human Development, Center for Interdisciplinary Research on Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
28
|
Allan-Blitz LT, Konda KA, Calvo GM, Vargas SK, Leon SR, Segura ER, Caceres CF, Klausner JD. High incidence of extra-genital gonorrheal and chlamydial infections among high-risk men who have sex with men and transgender women in Peru. Int J STD AIDS 2017; 29:568-576. [PMID: 29183269 DOI: 10.1177/0956462417744098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extra-genital Neisseria gonorrhoeae and Chlamydia trachomatis infections are associated with antimicrobial resistance and HIV acquisition. We analyzed data from a cohort of men who have sex with men (MSM) and transgender women followed quarterly for two years in Peru. Incident cases were defined as positive N. gonorrhoeae or C. trachomatis nucleic acid tests during follow-up. Repeat positive tests were defined as reinfection among those with documented treatment. We used generalized estimating equations to calculate adjusted incidence rate ratios (aIRRs). Of 404 participants, 22% were transgender. Incidence rates of rectal N. gonorrhoeae and C. trachomatis infection were 28.1 and 37.3 cases per 100 person-years, respectively. Incidence rates of pharyngeal N. gonorrhoeae and C. trachomatis infection were 21.3 and 9.6 cases per 100 person-years, respectively. Incident HIV infection was associated with incident rectal (aIRR = 2.43; 95% CI 1.66-3.55) N. gonorrhoeae infection. Identifying as transgender versus cisgender MSM was associated with incident pharyngeal N. gonorrhoeae (aIRR = 1.85; 95% CI 1.12-3.07) infection. The incidence of extra-genital N. gonorrhoeae and C. trachomatis infections was high in our population. The association with incident HIV infection warrants evaluating the impact of rectal N. gonorrhoeae screening and treatment on HIV transmission.
Collapse
Affiliation(s)
- Lao-Tzu Allan-Blitz
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA
| | - Kelika A Konda
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA.,2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gino M Calvo
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Segundo R Leon
- 3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eddy R Segura
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA
| | - Carlos F Caceres
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA.,4 Department of Epidemiology, Fielding School of Public Health, 12222 University of California Los Angeles , USA
| |
Collapse
|
29
|
Herrera MC, Konda KA, Leon SR, Brown B, Calvo GM, Salvatierra HJ, Caceres CF, Klausner JD, Deiss R. Do Subjective Alcohol Screening Tools Correlate with Biomarkers Among High-Risk Transgender Women and Men Who Have Sex with Men in Lima, Peru? AIDS Behav 2017; 21:253-261. [PMID: 29043467 PMCID: PMC7392030 DOI: 10.1007/s10461-017-1933-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Alcohol abuse can influence sexual risk behavior; however, its measurement is not straightforward. This study compared self-reported alcohol use, via the AUDIT and CAGE, with levels of phosphatidylethanol (Peth), a phospholipid biomarker that forms with chronic, heavy drinking, among high-risk MSM and TW in Lima, Peru. Chi square, Fisher's exact, Wilcoxon ranksum tests compared the instruments. Receiver operating curves determined sensitivity and specificity of the self-reported measures. Among 69 MSM and 17 TW, PEth was positive for 86% (95% CI 77-93%) of participants, while 67% reported binge-drinking in the last 2 weeks. The AUDIT classified 25% as hazardous drinkers while CAGE identified 6% as problem drinkers. Self-reported binge drinking was more sensitive than the AUDIT for PEth positivity (71% vs. 27%, p = 0.022). Among high-risk MSM and TW in Lima, validated, self-report measures of alcohol abuse underestimated biological measures. Further research correlating bio-markers and self-reported alcohol abuse measures is needed.
Collapse
Affiliation(s)
- M C Herrera
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
- Department of Pediatrics, University of California, San Francisco, CA, USA.
| | - K A Konda
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Center for Interdisciplinary Research in Sexuality, Society, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - B Brown
- Department of Social Medicine and Population Health, UCR School of Medicine, Riverside, CA, USA
| | - G M Calvo
- Center for Interdisciplinary Research in Sexuality, Society, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - H J Salvatierra
- Alberto Barton Health Center, Health Directorate of Callao, Lima, Peru
| | - C F Caceres
- Center for Interdisciplinary Research in Sexuality, Society, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J D Klausner
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - R Deiss
- Division of Global Public Health, UCSD School of Medicine, San Diego, CA, USA
| |
Collapse
|
30
|
Joseph Davey D, Kojima N, Konda KA, Gupta P, Leon SR, Calvo GM, Caceres CF, Klausner JD. Transient aortitis documented by positron emission tomography in a case series of men and transgender women infected with syphilis. Sex Transm Infect 2017; 93:551-555. [PMID: 28866636 DOI: 10.1136/sextrans-2017-053140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/02/2017] [Accepted: 05/06/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Syphilis infection persists globally contributing to preventable and treatable morbidity and mortality. How extensive early syphilis disseminates is unknown. To better understand the relationship between early syphilis infection and inflammation over time, our study enrolled six individuals recently infected with syphilis for sequential positron emission tomography (PET) scans. METHODS We evaluated a case series of six individuals with high syphilis titres (two secondary, two early latent and two latent, unknown duration, but with high titre) who received sequential PET scans to assess inflammation over time and its response to treatment. RESULTS At time of PET scan, four of the six individuals were co-infected with HIV. One of the four was not on antiretroviral therapy and three of the four were not virally suppressed (viral load of >400 copies/mL). Baseline rapid plasma reagin (RPR) titres ranged from 1:64 to 1:256 (four of the six participants had prior non-reactive RPR results). Five of the six participants had mild to intense hypermetabolic PET scan activity consistent with cervical (n=5), axillary (n=4), inguinal (n=5) and retroperitoneal (n=1) adenopathy. Mild hypermetabolic activity in the thoracic aortic wall, suggesting aortitis, was present among the same five participants and resolved within 30 days for four of the five participants and 60 days for the other participant. However, widespread lymphadenopathy remained present in PET scans up to 3 months following treatment in two participants. We did not find any abnormal PET scan activity of the central nervous system. CONCLUSION We found abnormal aortic wall PET scan activity suggesting aortitis to be common in a case series of patients with early syphilis. In research settings, PET scans may be a sensitive tool to monitor inflammation associated with syphilis.
Collapse
Affiliation(s)
- Dvora Joseph Davey
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Noah Kojima
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kelika A Konda
- David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Pawan Gupta
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Segundo R Leon
- Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gino M Calvo
- Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos F Caceres
- Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
31
|
Kojima N, Park H, Konda KA, Joseph Davey DL, Bristow CC, Brown B, Leon SR, Vargas SK, Calvo GM, Caceres CF, Klausner JD. The PICASSO Cohort: baseline characteristics of a cohort of men who have sex with men and male-to-female transgender women at high risk for syphilis infection in Lima, Peru. BMC Infect Dis 2017; 17:255. [PMID: 28399798 PMCID: PMC5387233 DOI: 10.1186/s12879-017-2332-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 03/21/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) and male-to-female transgender women (transwomen) are disproportionately at risk of syphilis infection in Peru. METHODS From 2013 to 2014, MSM and transwomen seeking human immunodeficiency virus (HIV) or sexually transmitted infection (STI) testing and/or treatment were recruited into a 2-year observational cohort study to determine predictors of recently acquired syphilis infection (defined as a rapid plasma reagin [RPR] titer ≥1:16 and a reactive treponemal antibody test) in Lima, Peru. At baseline, interviewers collected sociodemographic, behavioral, and medical characteristics from participants. All cohort participants were tested for syphilis, HIV, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) infection. Using cross-sectional analyses, bivariate and multivariate models were used to determine factors associated with recently acquired syphilis infection and calculate adjusted prevalence ratios. RESULTS We recruited 401 participants, 312 MSM and 89 transwomen, with median ages of 29.0 and 32.5 years old (interquartile ranges: 23.3, 37.4 and 27.2, 39.5, respectively). The prevalence of recently acquired syphilis infection at baseline was 16.8% for MSM and 6.7% for transwomen. Among MSM and transwomen, 30.1 and 33.7% were infected with HIV, 18.6 and 24.7% were infected with CT, and 14.2 and 19.1% were infected with NG, respectively. Co-infection rates among MSM with recently acquired syphilis infection included: 44.2% with HIV, 40.4% with CT (32.7% with anal CT and 7.7% with pharyngeal CT), and 19.2% with NG (11.5% with anal NG and 7.7% with pharyngeal NG). Co-infection rates among transwomen with recently acquired syphilis infection included: 66.7% with HIV, 0% with CT, and 16.7% with anal NG. In multivariate analysis among the entire cohort, recently acquired syphilis infection was independently associated with younger age (adjusted prevalence ratio [aPR] = 0.96, 95% confidence interval [CI] = 0.93-0.99), receptive role during anal sex (aPR = 2.56, 95% CI = 1.05-6.25), prior HIV diagnosis (aPR = 1.70, 95% CI = 1.11-2.61), anal CT or NG infection (aPR = 1.69, 95% CI = 1.09-2.60), and prior syphilis diagnosis (aPR = 3.53, 95% CI = 2.20-5.68). CONCLUSIONS We recruited a cohort of MSM and transwomen who had a high prevalence of recently acquired syphilis infection in Lima, Peru. Recently acquired syphilis infection was associated with socio-demographic characteristics, sexual risk, and sexually transmitted co-infections.
Collapse
Affiliation(s)
- Noah Kojima
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
| | - Hayoung Park
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
| | - Kelika A. Konda
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Dvora L. Joseph Davey
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA USA
| | - Claire C. Bristow
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA USA
| | - Brandon Brown
- Center for Healthy Communities, University of California Riverside, Riverside, CA USA
- Epicentro Salud, Lima, Peru
| | - Segundo R. Leon
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K. Vargas
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gino M. Calvo
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos F. Caceres
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D. Klausner
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA USA
| |
Collapse
|
32
|
Park H, Konda KA, Roberts CP, Maguiña JL, Leon SR, Clark JL, Coates TJ, Caceres CF, Klausner JD. Risk Factors Associated with Incident Syphilis in a Cohort of High-Risk Men in Peru. PLoS One 2016; 11:e0162156. [PMID: 27602569 PMCID: PMC5014407 DOI: 10.1371/journal.pone.0162156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 08/18/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Syphilis is concentrated among high-risk groups, but the epidemiology of syphilis reinfection is poorly understood. We characterized factors associated with syphilis incidence, including reinfection, in a high-risk cohort in Peru. METHODS Participants in the NIMH CPOL trial were assessed at baseline and 2 annual visits with HIV/STI testing and behavioral surveys. Participants diagnosed with syphilis also attended 4- and 9-month visits. All participants underwent syphilis testing with RPR screening and TPPA confirmation. Antibiotic treatment was provided according to CDC guidelines. Reinfection was defined as a 4-fold titer increase or recurrence of seroreactivity after successful treatment with subsequent negative RPR titers. The longitudinal analysis used a Possion generalized estimating equations model with backward selection of variables in the final model (criteria P <0.02). RESULTS Of 2,709 participants, 191 (7.05%) were RPR-reactive (median 1:8, range 1:1-1:1024) with TPPA confirmation. There were 119 total cases of incident syphilis, which included both reinfection and first-time incident cases. In the bivariate analysis, the oldest 2 quartiles of age (incidence ratio (IR) 3.84; P <0.001 and IR 8.15; P <0.001) and being MSM/TW (IR 6.48; P <0.001) were associated with higher risk of incident syphilis infection. Of the sexual risk behaviors, older age of sexual debut (IR 12.53; P <0.001), not being in a stable partnership (IR 1.56, P = 0.035), higher number of sex partners (IR 3.01; P <0.001), unprotected sex in the past 3 months (IR 0.56; P = 0.003), HIV infection at baseline (IR 3.98; P <0.001) and incident HIV infection during the study period (IR 6.26; P = 0.003) were all associated with incident syphilis. In the multivariable analysis, older age group (adjusted incidence ratio (aIR) 6.18; P <0.001), men reporting having sex with a man (aIR 4.63; P <0.001), and incident HIV infection (aIR 4.48; P = 0.008) were significantly associated. CONCLUSIONS We report a high rate of syphilis reinfection among high-risk men who have evidence of previous syphilis infection. Our findings highlight the close relationship between HIV incidence with both incident syphilis and syphilis reinfection. Further studies on syphilis reinfection are needed to understand patterns of syphilis reinfection and new strategies beyond periodic testing of high-risk individuals based on HIV status are needed.
Collapse
Affiliation(s)
- Hayoung Park
- UCLA David Geffen School of Medicine Program in Global Health, Los Angeles, CA, United States of America
| | - Kelika A. Konda
- UCLA David Geffen School of Medicine Program in Global Health, Los Angeles, CA, United States of America
- Universidad Peruana Cayetano Heredia, Unidad de Salud, Sexualidad y Desarrollo Humano, Lima, Peru
| | - Chelsea P. Roberts
- UCLA David Geffen School of Medicine Program in Global Health, Los Angeles, CA, United States of America
| | - Jorge L. Maguiña
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Segundo R. Leon
- Universidad Peruana Cayetano Heredia, Unidad de Salud, Sexualidad y Desarrollo Humano, Lima, Peru
| | - Jesse L. Clark
- UCLA David Geffen School of Medicine Program in Global Health, Los Angeles, CA, United States of America
| | - Thomas J. Coates
- UCLA David Geffen School of Medicine Program in Global Health, Los Angeles, CA, United States of America
| | - Carlos F. Caceres
- Universidad Peruana Cayetano Heredia, Unidad de Salud, Sexualidad y Desarrollo Humano, Lima, Peru
| | - Jeffrey D. Klausner
- UCLA David Geffen School of Medicine Program in Global Health, Los Angeles, CA, United States of America
- * E-mail:
| |
Collapse
|
33
|
Bustamante MJ, Konda KA, Joseph Davey D, León SR, Calvo GM, Salvatierra J, Brown B, Caceres CF, Klausner JD. HIV self-testing in Peru: questionable availability, high acceptability but potential low linkage to care among men who have sex with men and transgender women. Int J STD AIDS 2016; 28:133-137. [PMID: 26826160 DOI: 10.1177/0956462416630674] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
HIV status awareness is key to prevention, linkage-to-care and treatment. Our study evaluated the accessibility and potential willingness of HIV self-testing among men who have sex with men (MSM) and transgender women in Peru. We surveyed four pharmacy chains in Peru to ascertain the commercial availability of the oral HIV self-test. The pharmacies surveyed confirmed that HIV self-test kits were available; however, those available were not intended for individual use, but for clinician use. We interviewed 147 MSM and 45 transgender women; nearly all (82%) reported willingness to perform the oral HIV self-test. However, only 55% of participants would definitely seek a confirmatory test in a clinic after an HIV-positive test result. Further, price may be a barrier, as HIV self-test kits were available for 18 USD, and MSM and transgender women were only willing to pay an average of 5 USD. HIV self-testing may facilitate increased access to HIV testing among some MSM/transgender women in Peru. However, price may prevent use, and poor uptake of confirmatory testing may limit linkage to HIV treatment and care.
Collapse
Affiliation(s)
- Maria Jose Bustamante
- 1 Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kelika A Konda
- 1 Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru.,2 Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - Dvora Joseph Davey
- 3 Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Segundo R León
- 1 Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gino M Calvo
- 1 Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru.,4 Epicentro Salud, Lima, Peru
| | | | - Brandon Brown
- 6 Center for Healthy Communities, Division of Clinical Sciences, UCR School of Medicine, Riverside, CA USA
| | - Carlos F Caceres
- 1 Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- 2 Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles CA, USA.,3 Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
34
|
Allan-Blitz LT, Leon SR, Bristow CC, Konda KA, Vargas SK, Flores JA, Brown BJ, Caceres CF, Klausner JD. High prevalence of extra-genital chlamydial or gonococcal infections among men who have sex with men and transgender women in Lima, Peru. Int J STD AIDS 2016; 28:138-144. [PMID: 26846151 DOI: 10.1177/0956462416630909] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chlamydia trachomatis and Neisseria gonorrhoeae are among the most common sexually transmitted bacterial infections in the world. Data are limited, however, on the burden of extra-genital chlamydial and gonococcal infections among men who have sex with men and transgender women in Lima, Peru. Data were gathered from self-collected anal or pharyngeal swabs from participants in Lima, Peru, and analyzed via cross-sectional methods. Prevalence ratios for the association between extra-genital infection with socio-demographic and sexual behaviors were determined. Overall, 127 (32.8%) participants had anal or pharyngeal infections. On multivariate modeling, anal infection was positively associated with practicing both receptive and insertive anal sex, when compared to insertive alone (PR = 2.49; 95% CI = 1.32-4.71), and negatively associated with any antibiotic use in the prior three months (PR = 0.60; 95% CI = 0.39-0.91). Pharyngeal infection was negatively associated with age greater than 30 years compared to 18-30 years (PR = 0.54; 95% CI = 0.30-0.96), and positively associated with gender identity of transgender women (PR = 2.12; 95% CI = 1.20-3.73). This study demonstrates considerable burden of extra-genital chlamydial and gonococcal infections among men who have sex with men and transgender women in Lima, Peru.
Collapse
Affiliation(s)
- Lao-Tzu Allan-Blitz
- 1 David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Segundo R Leon
- 2 Laboratory of Sexual Health, Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,3 Department of Global Health, University of Washington, Seattle, WA, USA
| | - Claire C Bristow
- 4 Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Kelika A Konda
- 5 Department of Medicine, University of California Los Angeles, CA, USA
| | - Silver K Vargas
- 2 Laboratory of Sexual Health, Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan A Flores
- 2 Laboratory of Sexual Health, Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Brandon J Brown
- 6 Division of Clinical Sciences, Center for Healthy Communities, School of Medicine, University of California Riverside, CA, USA
| | - Carlos F Caceres
- 2 Laboratory of Sexual Health, Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- 1 David Geffen School of Medicine, University of California Los Angeles, CA, USA.,5 Department of Medicine, University of California Los Angeles, CA, USA
| |
Collapse
|
35
|
Herrera MC, Konda KA, Leon SR, Deiss R, Brown B, Calvo GM, Salvatierra HJ, Caceres CF, Klausner JD. Impact of alcohol use on sexual behavior among men who have sex with men and transgender women in Lima, Peru. Drug Alcohol Depend 2016; 161:147-54. [PMID: 26896169 PMCID: PMC4807690 DOI: 10.1016/j.drugalcdep.2016.01.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/26/2016] [Accepted: 01/26/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Alcohol use disorders (AUDs) may enhance the likelihood of risky sexual behaviors and the acquisition of sexually transmitted infections (STIs). Associations between AUDs with condomless anal intercourse (CAI) and STI/HIV prevalence were assessed among men who have sex with men (MSM) and transgender women (TW) in Lima, Peru. METHODS MSM and TW were eligible to participate based on a set of inclusion criteria which characterized them as high-risk. Participants completed a bio-behavioral survey. An AUDIT score ≥8 determined AUD presence. Recent STI diagnosis included rectal gonorrhea/chlamydia, syphilis, and/or new HIV infection within 6 months. Prevalence ratios (PR) were calculated using Poisson regression. RESULTS Among 312 MSM and 89 TW, 45% (181/401) had an AUD. Among those with an AUD, 164 (91%) were hazardous/harmful drinkers, and 17 (9%) had alcohol dependence. Higher CAI was reported by participants with an AUD vs. without, (82% vs. 72% albeit not significant). Reporting anal sex in two or more risky venues was associated with screening AUD positive vs. not (24% vs. 15%, p=0.001). There was no difference in recent STI/HIV prevalence by AUD status (32% overall). In multivariable analysis, screening AUD positive was not associated with CAI or recent STI/HIV infection. CONCLUSIONS In our sample AUDs were not associated with CAI or new HIV infection/recent STI. However higher prevalence of CAI, alcohol use at last sex, and anal sex in risky venues among those with AUDs suggests that interventions to reduce the harms of alcohol should be aimed toward specific contexts.
Collapse
Affiliation(s)
- M C Herrera
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - K A Konda
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - S R Leon
- Partners in Health, Director of Research, Lima, Peru
| | - R Deiss
- Division of Global Public Health, UCSD School of Medicine, San Diego, CA, USA
| | - B Brown
- Division of Clinical Sciences, Center for Healthy Communities, University of California, Riverside, CA, USA
| | - G M Calvo
- Unit of Health, Sexuality and Human Development, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - H J Salvatierra
- Alberto Barton Health Center, Health Directorate of Callao, Lima, Peru
| | - C F Caceres
- Unit of Health, Sexuality and Human Development, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J D Klausner
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| |
Collapse
|
36
|
Leon SR, Segura ER, Konda KA, Flores JA, Silva-Santisteban A, Galea JT, Coates TJ, Klausner JD, Caceres CF. High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in anal and pharyngeal sites among a community-based sample of men who have sex with men and transgender women in Lima, Peru. BMJ Open 2016; 6:e008245. [PMID: 26739719 PMCID: PMC4716251 DOI: 10.1136/bmjopen-2015-008245] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES This study aimed to characterise the epidemiology of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) and transgender women (TW) in Lima, Peru. SETTING Cross-sectional study in Lima, Peru. PARTICIPANTS We recruited a group of 510 MSM and 208 TW for a subsequent community-based randomised controlled trial. The presence of CT and NG were evaluated using Aptima Combo2 in pharyngeal and anal swabs. We also explored correlates of these infections. PRIMARY AND SECONDARY OUTCOME MEASURES Study end points included overall prevalence of C. trachomatis and N. gonorrhoeae in anal and pharyngeal sites. RESULTS Overall prevalence of CT was 19% (95% CI 16.1% to 22.1%) and 4.8% (95% CI 3.3% to 6.6%) in anal and pharyngeal sites, respectively, while prevalence of NG was 9.6% (95% CI 7.5% to 12.0%) and 6.5% (95% CI 4.8% to 8.5%) in anal and pharyngeal sites, respectively. CONCLUSIONS The prevalence of each infection declined significantly among participants older than 34 years (p<0.05). Efforts towards prevention and treatment of extraurogenital chlamydial and gonococcal infections in high-risk populations like MSM and TW in Lima, Peru, are warranted. TRIAL REGISTRATION NUMBER NCT00670163; Results.
Collapse
Affiliation(s)
- Segundo R Leon
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Cayetano Heredia University, Lima, Peru Department of Global Health, University of Washington, Seattle, Washington, USA Socios en Salud, Lima, Peru
| | - Eddy R Segura
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Kelika A Konda
- Division of Infectious Diseases, School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Juan A Flores
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Cayetano Heredia University, Lima, Peru
| | - Alfonso Silva-Santisteban
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Cayetano Heredia University, Lima, Peru
| | | | - Thomas J Coates
- Division of Infectious Diseases, School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jeffrey D Klausner
- Division of Infectious Diseases, School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Carlos F Caceres
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Cayetano Heredia University, Lima, Peru
| |
Collapse
|
37
|
Bristow CC, Leon SR, Huang E, Brown BJ, Ramos LB, Vargas SK, Flores JA, Caceres CF, Klausner JD. Field evaluation of a dual rapid diagnostic test for HIV infection and syphilis in Lima, Peru. Sex Transm Infect 2015; 92:182-5. [PMID: 26670914 DOI: 10.1136/sextrans-2015-052326] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/14/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Screening for HIV and syphilis in key populations is recommended by the WHO to reduce the morbidity, mortality and transmission associated with undiagnosed and untreated infections. Rapid point-of-care tests that can detect multiple infections with a single fingerprick whole blood specimen using a single device are gaining popularity. We evaluated the field performance of a rapid dual HIV and syphilis test in people at high risk of HIV and syphilis infections. METHODS Participants included men who have sex with men and transgender women recruited in Lima, Peru. Reference standard testing for detection of HIV and syphilis infections, conducted using blood samples from venipuncture, included Treponema pallidum particle agglutination and fourth-generation HIV enzyme immunoassay for which positive results had a confirmation HIV Western blot test. For the evaluation test, SD BIOLINE HIV/Syphilis Duo test (Standard Diagnostics, Korea), a fingerprick blood specimen was used. Sensitivity and specificity were calculated and the exact binomial method was used to determine 95% CIs. RESULTS A total of 415 participants were recruited for the study. The dual test sensitivity for detection of T. pallidum infection was 89.2% (95% CI 83.5% to 93.5%) and specificity 98.8% (95% CI 96.5% to 99.8%). For detection of HIV infection, the sensitivity of the dual test was 99.1% (95% CI 94.8% to 100%) and specificity 99.4% (95% CI 97.7% to 99.9%). CONCLUSIONS This high performing dual test should be considered for the use in clinical settings to increase uptake of simultaneous testing of HIV and syphilis and accelerate time to treatment for those who need it.
Collapse
Affiliation(s)
- Claire C Bristow
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Segundo R Leon
- Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Emily Huang
- Division of Infectious Diseases: Global Health, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Brandon J Brown
- Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Lourdes B Ramos
- Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan A Flores
- Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos F Caceres
- Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Division of Infectious Diseases: Global Health, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| |
Collapse
|
38
|
Kojima N, Bristow CC, Maecker H, Rosenberg-Hasson Y, Leon SR, Vargas SK, Konda KA, Caceres CF, Klausner JD. Similarities in the Markers of Inflammation Between Men With Syphilis and Women With Increased Risk of HIV Acquisition. Clin Infect Dis 2015; 62:265-6. [PMID: 26394671 DOI: 10.1093/cid/civ842] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | - Claire C Bristow
- Fielding School of Public Health, University of California Los Angeles
| | - Holden Maecker
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, California
| | - Yael Rosenberg-Hasson
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, California
| | - Segundo R Leon
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kelika A Konda
- David Geffen School of Medicine Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos F Caceres
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- David Geffen School of Medicine Fielding School of Public Health, University of California Los Angeles
| |
Collapse
|
39
|
Chow JY, Flores JA, Vargas SK, Leon SR, Konda KA, Klausner JD, Caceres CF. P07.13 Detection of treponema pallidumdna from whole blood and earlobe specimens in patients from two sti clinics in lima, peru. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
40
|
Flores JA, Vargas SK, Leon SR, Konda KA, Chow JY, Calvo GM, Salvatierra HJ, Brown B, Klausner JD, Caceres CF. P09.34 Molecular identification of treponema pallidumstrains from syphilitic lesions in sti clinic patients, lima, peru. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
41
|
Vargas S, Konda KA, Leon SR, Calvo G, Salvatierra HJ, Brown B, Klausner JD, Caceres CF. P17.04 The relationship between hiv testing frequency and hiv risk perception among peruvian msm and transgender women. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
42
|
Herrera MC, Konda KA, Leon SR, Wong P, Brown B, Caceres CF, Klausner JD. P11.22 Hepatitis c infections among high-risk men who have sex with men and transgender women in lima, peru. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
43
|
Herrera MC, Konda KA, Leon SR, Wong PA, Brown B, Caceres CF, Klausner JD. P11.21 Characterising the epidemiology of active hepatitis b virus infection among high-risk men who have sex with men and transgender women in lima, peru. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
44
|
Benites-Zapata VA, Konda KA, Leon SR, Chow J, Brown B, Caceres CF, Klausner JD. P11.18 Relationship between anal sex behaviours and incident syphilis infection among msm and transgender women from two clinics in lima peru. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
45
|
Bustamante MJ, Konda KA, León SR, Calvo G, Salvatierra J, Brown B, Caceres CF, Klausner JD. P17.02 Oraquick® in-home hiv test kit in peru: availability and acceptability among men who have sex with men and transgender women. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
46
|
Bristow CC, Maecker H, Rosenberg-Hasson Y, Leon SR, Vargas SK, Konda KA, Caceres CF, Klausner JD. P07.21 Serum cytokine analysis among patients with and without early syphilis infection. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
47
|
Calvo GM, Konda KA, León SR, Vargas S, Sánchez H, Salvatierra HJ, Brown B, Klausner JD, Caceres CF. P16.03 Comparison of sexual risk behaviours among hiv positive men who have sex with men before and after their diagnosis. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
48
|
Lee SW, Deiss RG, Segura ER, Clark JL, Lake JE, Konda KA, Coates TJ, Caceres CF. A cross-sectional study of low HIV testing frequency and high-risk behaviour among men who have sex with men and transgender women in Lima, Peru. BMC Public Health 2015; 15:408. [PMID: 25896917 PMCID: PMC4407786 DOI: 10.1186/s12889-015-1730-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 04/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased HIV testing frequency among high-risk populations such as men who have sex with men (MSM) and male-to-female transgender women (TW) can lead to earlier treatment and potentially reduce HIV transmission. METHODS We analyzed baseline survey data from 718 high-risk, young (median age 29 [interquartile range 23-35]) MSM/TW enrolled in a community-based HIV prevention trial between 2008-2009. Participants were recruited from 24 neighborhoods in and around Lima, Peru. We assessed HIV testing frequency, testing behaviour, and motivations and barriers to testing. Multivariate analysis identified correlates to prior HIV testing. RESULTS Overall, 79.6% reported HIV testing within their lifetimes, however, only 6.2% reported an average of two tests per year, as per Peruvian Ministry of Health guidelines. The most commonly reported motivators for testing were to check one's health (23.3%), lack of condom use (19.7%), and availability of free testing (14.0%), while low self-perceived risk for HIV (46.9%), fear of a positive result (42.0%), and lack of access to testing services (35.7%) were the most frequently reported barriers. In multivariate analysis, factors independently associated with HIV testing included age [adjusted prevalence ratio (APR) 1.00, 95% CI (1.00-1.01)], transgender-identification vs. gay-identification [APR 1.11, 95% CI (1.03-1.20)], history of transactional sex [APR 1.16, 95% CI (1.07-1.27)], and prior sexually transmitted infection diagnosis [APR 1.15, 95% CI (1.07-1.24)]. CONCLUSIONS An overwhelming majority of participants did not meet the standard-of-care for testing frequency. The reported motivations and barriers to testing highlight issues of risk perception and accessibility. Our findings suggest utilizing non-traditional outreach methods and promoting HIV testing as a routine part of healthcare in Peru to encourage testing and knowledge of HIV serostatus.
Collapse
Affiliation(s)
- Sky W Lee
- Division of Infectious Diseases, University of California, Los Angeles, California, USA.
| | - Robert G Deiss
- Division of Global Public Health, University of California, La Jolla, San Diego, California, USA.
| | - Eddy R Segura
- Division of Infectious Diseases, University of California, Los Angeles, California, USA.
| | - Jesse L Clark
- Division of Infectious Diseases, University of California, Los Angeles, California, USA.
| | - Jordan E Lake
- Division of Infectious Diseases, University of California, Los Angeles, California, USA.
| | - Kelika A Konda
- Division of Infectious Diseases, University of California, Los Angeles, California, USA.
| | - Thomas J Coates
- Division of Infectious Diseases, University of California, Los Angeles, California, USA.
| | - Carlos F Caceres
- Unidad de Salud Sexualidad y Desarrollo Humano, Universidad Peruana Cayetano Heredia, Lima, Peru.
| |
Collapse
|
49
|
Paiva V, Ferguson L, Aggleton P, Mane P, Kelly-Hanku A, Giang LM, Barbosa RM, Caceres CF, Parker R. The current state of play of research on the social, political and legal dimensions of HIV. CAD SAUDE PUBLICA 2015; 31:477-86. [PMID: 25859715 PMCID: PMC4603422 DOI: 10.1590/0102-311x00172514] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/10/2014] [Indexed: 11/22/2022] Open
Abstract
This paper offers a critical overview of social science research presented at the 2014 International AIDS Conference in Melbourne, Australia. In an era of major biomedical advance, the political nature of HIV remains of fundamental importance. No new development can be rolled out successfully without taking into account its social and political context, and consequences. Four main themes ran throughout the conference track on social and political research, law, policy and human rights: first, the importance of work with socially vulnerable groups, now increasingly referred to as "key populations"; second, continued recognition that actions and programs need to be tailored locally and contextually; third, the need for an urgent response to a rapidly growing epidemic of HIV among young people; and fourth, the negative effects of the growing criminalization of minority sexualities and people living with HIV. Lack of stress on human rights and community participation is resulting in poorer policy globally. A new research agenda is needed to respond to these challenges.
Collapse
|
50
|
Bristow CC, Konda KA, Wong J, Caceres CF, Klausner JD. Choosing a metric for measurement of pre-exposure prophylaxis. Lancet Infect Dis 2014; 14:1177-1178. [PMID: 25455980 PMCID: PMC4507263 DOI: 10.1016/s1473-3099(14)70989-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Claire C Bristow
- Fielding School of Public Health, University of California Los Angeles, 9911 W Pico Blvd, St 955, CA 90035, USA.
| | - Kelika A Konda
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jordan Wong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Carlos F Caceres
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Fielding School of Public Health, University of California Los Angeles, 9911 W Pico Blvd, St 955, CA 90035, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|